Expanding horizons to include telemedicine in skilled nursing facilities
Viktoriya Friedman, MSPT
An elderly woman slowly reaches for her alarm clock and thinks, “It's 7:45 already?! I better get going.” Though she is fully aware that her doctor's appointment is not until 1:30, she gets uneasy and attempts to rush, as she hates being late. Slowly, she shuffles to take her first dose of Carbidopa-Levodopa (Sinemet). She shuffles from her room to the bathroom, then out into the kitchen, where I wait patiently. I try to hide my eagerness to look at my watch, but she knows. “It takes me an hour in the morning before I feel like a human being,” she says.
Carol is a typical 76-year-old female living with Parkinson's disease. For people who live with this disease, life can be slow. It can be unpredictable. It can be exhausting. Carol would have to travel more than 100 miles to see the closest movement disorders specialist in our area, a specialist who can thoroughly focus on her diagnoses. With her movement disorder and impaired mobility at baseline, enduring such a ride is impossible. In Carol's situation, having direct access to a specialist from her home or an easily accessible site is a much preferred option.
Patient- centered care and higher standards for quality of care, combined with an accelerated pace of medical innovation, demand SNFs to provide easy access to specialists through telemedicine. In a recent Wall Street Journal article, the author described how hospitals are using interactive video to give patients more access to medical care. So why not nursing homes?
SNFs are providing care to residents with issues requiring medical specialists. But getting to these specialists is difficult, not timely and very costly. Three years ago, our facility piloted a telemedicine program by partnering with Kevin Biglan, M.D., from the University of Rochester to help optimize care for inpatient residents living with Parkinson's disease. The word spread quickly into the community and requests quickly grew. Dr. Biglan, one of the top five movement disorders specialists in this country, would not be available to our residents if this telemedicine program did not exist. For people like Carol, who are not able to travel, having an easy access to a specialist has made a huge impact. She no longer freezes in the morning and her medications have been changed to match the symptoms of her disease process, yielding a better quality of life.
As part of the healthcare reform, the US government implemented incentives as well as penalties for organizations who fail to adopt electronic health records by 2015. Major goals underlying this initiative were to improve quality and efficiency of care, as well as facilitate coordination of services among referral and interdisciplinary team sources. Since the transition to electronic health records, telemedicine has emerged as the means to effectively address issues of cost, coordinate care and provide access to specialty care. Telemedicine, which simply refers to electronic exchange of medical information to optimize patient outcomes, has been effectively used in critical care models for decades and it is starting to make way into urban homes and SNFs. Sustainability in healthcare is a concrete imperative. In order to achieve and maintain sustainability in light of escalating costs and budget cuts, SNFs must transform along with the Medicare reform. Our SNF uses specialized care across a wide continuum of care and easy accessibility to specialists via telemedicine as ways to advance in the industry.
Telemedicine program is not only a great niche for SNFs, but can also aide in revenue to the facility. Therapist and nurse are incorporated into the telemedicine visits with Dr. Biglan, thus obtaining most up-to-date information to assist with treating residents. This communication is imperative and integral in providing optimal quality of care. As our telemedicine program expanded, local physicians and residents were interested in outpatient therapy services, so we opened up an outpatient therapy clinic. We also created a SNF-based, free wellness program for residents living with movement disorders called ParkFIT, to focus on prevention and maintenance. It's the only one in the area.
These efforts have paid off. Out of nine SNFs in the area, we have the lowest hospital readmission rates and consistently great customer satisfaction surveys. We are getting closer to mitigating the loophole in SNF healthcare by providing specialized therapy services, easy access to specialized medical services, in addition to wellness classes. It's all a part of helping our residents maintain a high quality of life.
Viktoriya Friedman, MSPT, is the regional director of rehabilitation services at VESTRACARE in Johnson City, NY.